Oral Biology and Dentistry

ISSN 2053-5775 | Volume 7 | Article 1

Original Research Open Access

Effects of Khat Extract and Other Staining Media on Color

Change of Composite Resins Subjected to Various
Polishing Methods
Waled A. Al-Anesi1*, Ahmed A. Madfa1,2, Mohammed A. Dubais1 and Aulfat A. Albahari1

*Correspondence: walidalanesi@gmail.com CrossMark

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1
Restorative and Prosthodontic Department, Collage of Dentistry, University of Science and Technology, Yemen.
2
Department of Conservative Dentistry, Faculty of Dentistry, Thamar University, Yemen.

Abstract
Objective: To assess the influence of Khat extract and other staining media on color changes in composite
resins subjected to various polishing methods.
Methods: 84 disk-shaped specimens (8 mm in diameter and 2 mm thick) were prepared for each composite
resin type [nanohybrid (Filtek Z250 XT), nanofilled (Filtek Z350 XT), and microhybrid zirconia/silica
(Valux Plus)], for a total of 252 specimens. Each composite group was divided into three subgroups
according to polishing methods (n=28): control (no finishing and polishing), polishing Praxis disks, and
polishing felt disks. After finishing and polishing, seven specimens from each group were immersed in Khat
extract, tea, Pepsi, and distilled water for 7 days. Color parameters were measured before immersion and
after the allocated time of immersion. Three-way analyses of variance followed by a one-way ANOVA and
Tukey’s test were used for the statistical analysis.
Results: A significant interaction between the resin composites, polishing methods, and staining solutions
were found (p<0.05). The polishing effect on the resin composite color stability was not statistically
significant (p>0.05). Of the staining solutions, Khat extract induced the highest level of discoloration. Khat
extract and tea revealed significantly more color changes than Pepsi and distilled water (p<0.05). Of the
composite resins, the Valux Plus showed the lowest ΔE* value, whereas the Filtek Z250 showed the highest
(p<0.05).
Conclusions: Khat extract showed the highest effects on the color stability of different types of composite
resins. Only Khat extract and tea produced clinically perceptible color changes (ΔE>3.3).
Keywords: Discoloration, composite resin, polishing, staining solutions, Khat extract

Background more, a rough surface adds to patient discomfort, as a change

Among direct restorative materials, composite resin is considered
the material of choice when esthetic appearance is a concern
[1,2]. However, when this material is present in the oral environ-
ment, it becomes vulnerable to the influence of some factors
that may result in staining [3]. Composite resin staining might
be attributed to the water sorption degree and matrix resin
hydrophilicity. If a composite resin can absorb water, it can
also absorb other fluids, resulting in color alteration. Further-
in surface roughness can be detected by the tip of the tongue.
In addition, changes in biofilm accumulation on the surface
roughness were reported, which leads to discoloration and/or
staining of the restoration or margins [4]. Previous studies have
shown that composite resins are susceptible to color instability
when exposed to various staining media, especially red wine,
coffee, cola, tea, and whisk [5-9].
Khat is a natural stimulant from the Catha edulis plant that

© 2019 Al-Anesi et al; licensee Herbert Publications Ltd. This is an Open Access article distributed under the terms of Creative Commons Attribution License
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Al-Anesi et al., Oral Biology and Dentistry 2019,
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is cultivated in the Republic of Yemen and most East African
countries. Its young buds and tender leaves are chewed to
attain a state of euphoria and stimulation [10]. Khat is an
evergreen shrub that is cultivated as a bush or small tree.The
leaves have an aromatic odor. The taste is astringent and
slightly sweet. The plant is seedless and hardy, growing in a
variety of climates and soils. Khat can be grown in droughts
where other crops have failed and also at high altitudes. Khat
is harvested throughout the year. Planting is staggered to
obtain a continuous supply. There is fairly extensive litera-
ture on the potential adverse effects of the habitual use of
Khat on mental, physical, and social well-being [11]. Many
different compounds are found in Khat including alkaloids,
terpenoids, flavonoids, sterols, glycosides, tannins, amino
acids, vitamins, and minerals. The phenylalkylamines and
the cathedulins are the major alkaloids and are structurally
related to amphetamine [12].
Some studies have reported high surface roughness of
composites, even after finishing, due to irregularly arranged
inorganic filler particles, which could result in easier staining
over time [6,8,13]. Fundamentally, filler particle size and distri-
bution as well as resin matrix composition have been shown
to play an important role in the color stability of composite
resins. The filler load improves the physical properties and
resistance to functional wear. Due to increasing filler load,
the viscosity increases [14,15]. The composites initially were
quartz-filled with large filler particles, which make restorations
rough and difficult to polish. Because the polishing ability of
restorations is a major aesthetic problem, a variety of newer
materials have been developed due to the growing needs
expressed by dental practitioners. Composite resins derive
their physical properties/handling characteristics from the
reinforcing filler particles and viscosity of the resin matrix.
The majority of direct restorative composite resins fall into
one of the following categories: hybrid, flowable, microfilled,
packable, and nanofilled composites [16].
Clinically, the longevity of restorations is mostly related to
acceptable finishing and polishing properties that provide
smooth surfaces. It has been reported that higher surface
roughness values (>0.2 𝜇m) are a risk factor for extensive
plaque accumulation on dental materials and the main con-
tributor to the multifactorial discoloration of resin restorations
[17]. Both esthetics and the longevity of restorations strongly
depend on the quality of surface finishing and polishing. Ir-
regularities can influence the appearance, plaque retention,
surface discoloration, gingival inflammation, solubility of the
organic matrix due to the formation of lactic acids, propionic,
and acetic by adhered plaque and secondary caries occurrence
[18]. Some mechanical properties such as hardness can be
reduced due to the surface roughness of composite restora-
tions and also increase restoration wear. For these reasons,
polished and smooth composite resin restorations improve
esthetic appearance and increase longevity [18].
Various finishing and polishing techniques have been tested
doi: 10.7243/2053-5775-7-1
with different types of composite resins to obtain a smooth
surface. However, resin-based composites are not yet able to
guarantee excellent results when used due to exposure to
various staining media in oral environments that vary between
different countries. To date, no types of composite resins and
finishing and polishing techniques have been developed to
eliminate discoloration under various staining media. Therefore,
this subject remains controversial. Thus this is the theme of
the current study. The purpose of this in vitro study was to
evaluate the effects of Khat extract and other staining media
on the color stability of three different types of composite
resins after subjecting them to various polishing methods.
The null hypothesis of this study was that the color stability
of different composite resins would not be affected by Khat
extract and other staining media after subjecting them to
various polishing methods.
Materials and methods
Three types of light-cured resin composite resin materials,
nanohybrid (Filtek Z250 XT), nanofilled (Filtek Z350 XT), and
microhybrid zirconia/silica (Valux Plus), three polishing meth-
ods (polyester strip without finishing and polishing, praxis
disks, and felt disks in combination with Poligloss aluminum
oxide paste), and four storage media (distilled water, Pepsi,
tea, and Khat extract) were used (Figure 1). Table 1 shows the
characteristics of the composite resin materials and polishing
systems used in this study.
For each type of composite resin, 84 disk-shaped specimens
were prepared, for a total of 252 disks. The composite discs
were fabricated using Teflon molds [19]. A Teflon plate with a
hole (8 mm in diameter and 2 mm thick) was prepared [20-22].
After a composite resin material was packed into the hole in
the Teflon plate, a polyester strip was placed on the composite
surface to smooth it. A glass slide was placed over the polyester
strip to ensure excess composite resin material was extruded
after pressure was applied [8,23]. All of the composite disk
specimens were cured for 40 s with light-emitting diodes
(Coolight Light Cure Unit, Gyeonggi-do, Korea) with a peak
wave length of approximately 470 nm. All of the specimens
were then immersed in distilled water for 24 h at 37ºC for
rehydration and polymerization completion [24].
Specimens of each composite resin were divided into three
groups, each containing 28 specimens. In all of the groups,
a control group of 28 specimens received no finishing and
polishing. The remaining 56 specimens were finished with
fine grit diamond burs applied for 15 s and then extra-fine
diamond burs applied for 15 s under running water. The 56
specimens were randomly divided into two groups (n=28/
group) according to the polishing method.
The specimens were polished using one of the following methods:
a) Using Praxis disks (TDV, Santa Catarina, Brazil), the speci-
mens were sequentially polished with coarse, medium, fine, and
extra-fine aluminum oxide abrasive discs under running water
at low speed for 60 s according to the manufacturer’s instruction.
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Figure 1. Distribution of the study sample.

Table 1. The characteristics of the composite resin materials and polishing systems used in this study.
A. Composite materials
Composite material Shade Filler type Filler by Composition Manufacturer
volume
3M Filtek Z250 XT A3 Nanohybrid 60% Monomers: Bis-GMA, UDMA, and 3M ESPE, St. Paul, MN, USA
Bis-EMA
Filler: Zircon and SiO2 0.6 mm
(0.01-3.5 mm)
3M Filtek Z350 XT A3 Nanofiller 59.5% Monomers: Bis-GMA, UDMA, 3M ESPE, St. Paul, MN, USA
TEGDMA, and Bis-EMA
Filler: Aggregated zirconia (0.6-1.4
mm) and non-aggregated SiO2 (20 nm)
3M Valux Plus A3 Microhybrid 66% Monomers: Bis-GMA and TEGDMA 3M ESPE, St. Paul, MN, USA
Filler: Single filler 100% zirconia/silica
(0.01-3.5 mm)
B. Polishing systems
Polishing systems Composition Manufacturer
Praxis discs 4 grits codified by color of aluminum oxide, polyethylene terephthalate, syn- TDV, Santa Catarina, Brazil
thetic rubber resin, aluminum, and water-based pigments
Felt discs Natural wool wheels TDV, Santa Catarina, Brazil
Poligloss polishing paste Aluminum oxide TDV, Santa Catarina, Brazil
Bis-GMA=bisphenol-A-glycidyl methacrylate; Bis-EMA=bisphenol-A-ethoxylateglycidyl methacrylate; TEGDMA=triethylene glycol
dimethacrylate; UDMA=urethane dimethacrylate.

b) The specimens were polished using felt disks (TDV, Santa
Catarina, Brazil) in combination with Poligloss aluminum oxide
polishing paste (TDV, Santa Catarina, Brazil) at low speed for
60 s according to the manufacturer’s instruction.
All of the procedures were carried out by the same operator
(specimen preparation, finishing, and polishing) [25].
The tea (Al-Kbous Tea, Sana’a, Yemen) was prepared by imm-
ersing 2 prefabricated tea bags (200 mg per bag) into 300 mL
of boiling distilled water for 10 min according to the manufac-
turer’s recommendation [26]. Khat (Ansy Khat, Sana’a, Yemen)
was used for extract preparation. Initially, fresh leaves and
twigs of Khat were cleaned, air-dried, and packed in plastic
bags and sent to the laboratory. Khat extract was prepared
by immersing 20 g aliquots of the dried material into 500 mL
of distilled water. Afterward, it was shaken at 200 rpm for 5 h
at 37ºC. After 5 h of shaking, medium grade filter papers were

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used to filter the water extracts. Then fresh stock solutions

were prepared by dissolving 5 g of the dried extract in 25
mL of distilled water [27]. Aqueous Khat extract with mineral
water was prepared by adding 100 g of Khat extract to 100
mL of mineral water at a ratio of 1:1. The same procedures
were executed daily to obtain fresh solutions.
The tested materials were subdivided into 4 groups (n=7).
All of the specimens in each group were immersed into dis-
tilled water, Pepsi, tea, and Khat extract. The solutions were
replaced each day, and the specimens were washed with
distilled water and dried with absorbent paper before the
new immersion. The specimens of each subgroup were im-
mersed in the tested solutions for 3 h daily for 7 days at 37°C
[24]. Following completion of the immersion, the specimens
were rinsed under running distilled water and air-dried.
After 24 h, when the polymerization was complete, L*, a*,
and b* (CIE system) values of the specimens were measured
using a colorimeter (Portable Color Difference Meter TCD 100,
PCE Instruments UK Ltd, Hampshire, UK) using the equation:

∆E = [(L*1-L*0)²+ (a*1-a*0)²+(b*1-b*0)²]½ Figure 2. Mean color change (ΔE values) of the tested resin
composites for all of the polishing methods in all of the
Each specimen was measured twice and then the average staining media.
values were calculated. Color measurement was recorded again,
after 7 days of immersion in the solutions, for all of the groups
using the same previously described method. For reproduc- found with Valux Plus in all polishing methods and staining
ible readings, the stained specimens were allowed to air-dry media. According to three-way ANOVA, a significant interac-
at room temperature for 30 min before the measurements. tion between three resin composites, staining media and
The second measurement served as the treatment for each polishing methods was noticed (p<0.05). Table 2 displays the
specimen to enable the calculation of the color change (ΔE). mean color change (ΔE values) ± standard deviation of the
For reliability, 10% of the specimens were chosen randomly materials for all polishing methods in all staining media after
and tested. After 2 weeks, the tests were repeated again and 7 days. Composite materials were compared according to the
then the results were compared using Cronbach’s alpha test. effects of different polishing methods in all staining media.
All of the data were collected and statistically analyzed There were no significant differences among the polishing
using the Statistical Package for Social Science version 20.0 methods (p>0.05).
(SPSS Inc., Chicago, IL, USA). The assumptions of a normal Table 3 compares the differences between the ΔE values of
distribution were met after results of the Shapiro-Wilk test all staining media for all composites. Only Khat extract and
(p>0.05), therefore parametric tests were used. Three-way tea produced clinically perceptible color change (ΔE>3.3).
ANOVA was used to assess the effects of different polishing Among the four treatment solutions, Khat extract induced
methods, storage media, and composites on the color change the highest level of discoloration. Least discoloration was
values, including the possibility of interaction of the three found with distilled water. Khat extract and tea revealed sig-
factors. Because significant interaction effects were found, nificantly more color change than pepsi and distilled water
subgroup analysis using one-way ANOVA/Tukey’s HSD was for all tested composites and all polishing methods (p<0.05).
applied. When polishing systems and staining media were fixed, there
were significant differences between Filtek Z250 XT and Valux
Results Plus (p<0.05). However, there were no significant differences
The reliability test was performed after two weeks of re- between Filtek Z350 XT and Valux Plus and between Filtek
examination of 10% of the specimens. Cronbach’s Alpha value Z250 XT and Filtek Z350 XT (p>0.05) as shown in Table 4.
was 0.998, which indicates a high level of internal consistency
for our sample data’s. Discussion
The mean color change (ΔE values) of tested resin compos- Composite resin restorations must match in shape and shade
ites for all polishing methods in all staining media is exposed with the adjacent natural teeth. They must not only function
in Figure 2. Generally, Filtek Z250 XT showed more color properly but also fulfill aesthetic demands. However, discolora-
change than Filtek Z350 XT, however least color change was tion of resin composites may be a major cause for replacement

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Table 2. Mean color change (ΔE values) ± standard deviation of the materials
for all of the polishing methods in all of the staining media after 7 days.
Composite Staining media Without polishing Praxis discs Felt discs
3M Z250 Water 0.8±0.25 1.1±0.21 0.9±0.39
Tea 7.7±0.91 9.5±0.67 9.5±1.08
Pepsi 0.8±0.15 0.9±0.39 0.99±0.40
Khat extract 16.2±7.47 11.2±3.57 13.9±5.14
3M Z350 Water 0.8±0.37 1.5±0.36 0.96±0.39
Tea 6.1±0.45 7.2±0.60 7.2±0.66
Pepsi 0.9±0.19 0.9±0.47 0.8±0.53
Khat extract 12.8±1.88 7.8±0.94 6.9±2.92
3M Valux Water 1.3±0.49 0.97±0.49 0.5±0.42
Tea 6.0±1.49 8.5±1.18 8.4±1.12
Pepsi 1.5±0.42 1.5±0.41 1.1±0.40
Khat extract 4.3±0.82 5.7±0.88 4.8±1.58

Table 3. Comparison between three composites for each of restorations [28]. The color stability of composite resins is
staining media in all of the polishing methods. influenced by both extrinsic and intrinsic factors. Extrinsic
Polishing methods Staining media P value
factors include the duration and intensity of light emission
during the curing process, exposure to environmental factors
Without polishing Water Tea 0.001 such as ambient and ultraviolet radiation, water, heat, and
Pepsi 1.001 food colorants. Intrinsic factors include composition of the
Khat extract 0.001 resin matrix, filler loading and particle size distribution, type of
Tea Pepsi 0.001 photoinitiator, and percentage of remaining C=C bonds [29].
Khat extract 0.001 Discoloration of dental materials can be evaluated by visual
Pepsi Khat extract 0.001 or instrumental techniques [30-32]. Visual methods involve
Felt discs Water Tea 0.001 comparison using the eyes [28], whereas instrumental methods
Pepsi 0.997 involve the use of a colorimeter and spectrophotometer [33].
Khat extract 0.001 Color evaluation by visual comparison may not be a reliable
Tea Pepsi 0.001 method due to discrepancies inherent in the perception of
Khat extract 0.997 color and the specification of observers. Instrumental tech-
Pepsi Khat extract 0.001 niques include colorimetry, spectrophotometry, and digital
Praxis discs Water Tea 0.001 image analysis. The CIE Lab system for measuring chromaticity
Pepsi 0.998 and recording color differences was used in this study because
Khat extract 0.001 it is suitable for the identification of small color changes and
Tea Pepsi 0.001 has the advantages of repeatability, sensitivity, and objectiv-
Khat extract 0.987 ity [34]. A colorimeter (Portable Color Difference Meter TCD
Pepsi Khat extract 0.001 100, PCE Instruments UK Ltd, Hampshire, UK) was used in this
P<0.05 for one-way ANOVA. Tukey’s HSD test for study. ΔE<3.3 was considered clinically acceptable, for color
multiple comparisons was applied. changes that cannot be detected by the human eyes [29,35,36].
Routine food habits can affect the esthetic quality of com-
Table 4. Multiple comparisons of the
posite restorations. Consequently, studies have reported the
mean color change (ΔE values) between susceptibility of resin materials to staining after immersion in
three composites. solutions such as coffee [37-39], red wine [39,40], tea [39,41-43],
Composite P value soft drinks [39,42], and juices [8]. The present study addressed
3M Z250 3M Z350 0.055 the problem of color stability of resin-based composites by
3M Valux 0.002 investigating their susceptibility to stains caused by commonly
3M Z350 3M Valux 0.521 consumed types of liquids (such as tea and Pepsi) and Khat,
which is the most common social habit in daily life in Yemen
P<0.05 for one-way ANOVA.
Tukey’s HSD test for multiple (south of the Arabian Peninsula). To the best of our knowledge,
comparisons was applied. there are no previous published studies concerning the color

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stability of composite resins with Khat. In Yemen, Khat chewing
is one of the most common habits that may affect the color
of esthetic restoration. Khat is the name generally used for
Catha edulis forssk, a dicotyledonous evergreen shrub [44].
Khat has been chewed in Ethiopia since ancient times, and
its use spread to east African countries [45] and South Africa
[11]. It also has been used in Yemen since the sixth century
[46]. Khat chewing has been considered a Muslim habit, and
some authors relate its use to Muslim ceremonies However,
its use has recently spread to various European, and Asian
countries, and Australia [47].
The colorant’s polarity can determine its degree of compos-
ite penetration. Less polar colorants may be easily absorbed
inside the material, whereas more polar colorants tend to
be adsorbed on the surface of the material [48]. In this study,
immersion in staining media showed diverse effects on the
color change of the three tested materials. The present findings
indicated that Khat extract as well as tea induced the most
color change in all of the materials, which were either polished
or not polished. The color change values for all of the tea and
Khat extract groups were greater than 3.3. These values were
considered clinically unacceptable. The color change occurred
due to a combination of intrinsic and extrinsic discoloration.
Intrinsic discoloration may occur due to the penetration of
yellow pigments through micro-cracks or interfacial gaps
at the interface between the filler and the matrix. Extrinsic
discoloration may be due to the adsorption of polar colorants
and yellow pigments present in tea onto the surface of resin
composite materials [49]. Many studies reported that the tan-
nic acid naturally present in tea is responsible for significant
color changes of composite resins [43,50-52]. However, crude
Khat has tannins and some amount of fluoride, which may
be the cause of staining [53,54], particularly in unpolished
nanohybrids and nanofilled composite resins. In a case-control
study by Yarom et al. investigating the effects of Khat chew-
ing on oral and dental tissues among Yemeni Jews in Israel
[55], teeth staining were found in 91.2% of the Khat chewers,
while no staining was found in the controls. The authors at-
tributed teeth discoloration to the stains caused directly by
the chemicals (tannins) in Khat leaves.
Water absorption seems to affect the optical properties of
composites in terms of their susceptibility to extrinsic stains
and degradation. Water may decrease the durability of composite
resins by expanding and plasticizing the organic matrix, which
creates micro-cracks [38,56] and a high level of porosity that
may facilitate fluid transport into and out of the polymer [56-58].
Thus, water may act as a vehicle for dye penetration [56,57].
All of the composite resins in this study that were immersed
in distilled water showed clinically acceptable color changes.
This observation confirms that water sorption itself did not alter
the color of the composites to a significant extent because
distilled water has no colorant components. However, some
studies found that composite resins immersed in distilled
water showed a gradual increase in staining of the composite
doi: 10.7243/2053-5775-7-1
resin when the samples were not subjected to finishing and
polishing after 7 days. This could be the result of intrinsic dis-
coloration [19].
Several studies have shown that the smoothest surface is
obtained when the resin is polymerized against a polyester
strip [3,40]. However, this smooth surface is rich in organic
matrix [59] and presents a lower microhardness than polished
surfaces, probably because this resin-rich layer has poor physi-
cal and mechanical properties [3,40]. The polyester strips used
in the preparation of the specimens in all of the groups (with
and without finishing/polishing) allowed a greater surface
smoothness, thus decreasing the roughness of the resin and
consequently the possibility of staining. According to Patel
et al. [6], when resins are polymerized in air, the polymeriza-
tion of the surface layer is inhibited by oxygen. Thus, the use
of a polyester strip promotes greater surface smoothness in
addition to preventing contact of the material with air, there-
fore eliminating the layer of unpolymerized resin. However,
Dietschi et al. [60] found the area under the polyester strip
appeared to have a lower degree of polymerization than the
rest of the restoration. Theoretically, this could increase the
restoration susceptibility to staining. In this situation, the
finishing and polishing procedure could contribute to the
color stability because it removes this surface resin matrix.
Therefore, polishing tools used over the years range from
multiple-step systems using fine and superfine diamond
burs, aluminum oxide abrasive disks, and diamond and silicon
impregnated rubber cups, to one-step polishing systems such
as diamond-impregnated cups and silicon carbide brushes
[61]. However, in this study, the removal of the surface layer
of the resin by finishing/polishing did not affect the color
stability. The smoothest surface was not necessarily the most
stain resistant [62], which may support the hypothesis that
discoloration is not exclusively dependent on the surface
roughness but exposure to the staining media may change
the surface quality and predispose materials to discoloration
[63]. Similar results to the present study were also found by
Bagheri et al. [7] and Nagem Filho et al. [64].
Another factor considered in the present study might be
the types of disks used that have limitations due to their
geometry [65,66]. Barbosa et al. [59] observed that the use of
diamond burs produced scratches on the composite surface;
discs caused some surface damage that may have been due to
the loss of particles during polishing with abrasive materials
[67]. Nonetheless, the polishing phase plays a critical role in
the restoration process. However, polishing may result in an
increase in surface roughness, with important consequences
on plaque adhesion, surface pigmentation, and composite
marginal integrity [65].
Among the three composite resins, Filtek Z250 XT was
associated with the highest discoloration, whereas the least
discoloration was associated with Valux Plus, irrespective
of the immersion media, finishing, and polishing (Figure 2).
Therefore the null hypothesis of this study were accepted
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which is the color stability of different composite resins would
not be affected by Khat extract and other staining media after
subjecting them to various polishing methods. Significant
staining is generally associated with the hydrophilic nature of
the composite matrix [48]. Hydrophobic materials are stained
by hydrophobic solutions, and hydrophilic materials with
high water absorption are stained by hydrophilic colorants
in aqueous solutions [48].
The type of monomer in the resin was another factor re-
sponsible for increased staining. Awliya et al. [63] found that
composites with Bis-GMA-based resins had greater water
sorption than other composites. The water uptake in the Bis-
GMA-based resins increased from 3% to 6% as a proportion
of the triethylene glycol dimethacrylate (TEGDMA) increased
from 0% to 1%. Furthermore, resins with higher concentrations
of TEGDMA were more prone to color change. This monomer
has a highly hydrophilic nature, which increases water and
other fluid sorption [37]. In the present study, the Filtek Z250
XT had significantly greater color change than the Filtek Z350
XT. This may be because the Filtek Z350 XT has small amount
of TEGDMA associated with Bis-EMA, which has a matrix with
hydrophobic features [68].
However, the microhybrid resin (Valux Plus) showed the
lowest ΔE* values compared to the other composite resins.
The low staining susceptibility of Valux Plus was most prob-
ably linked to its low water sorption rate, which in turn was
related to its hydrophobic matrix [69]. Filler loading also
plays an important role in composite discoloration [70]. Kim
et al. [71] found that increased filler loading resulted in lower
water absorption. The filler loading by weight of Valux Plus
was 66% whereas that of Z250 XT and Z350 XT were 60% and
59.5%, respectively. This might be the reason that Valux Plus
had the lowest ΔE* values than the other composite resins
used in this study. In addition, it is well known that vitamin
C (ascorbic acid) has a low pH and can contribute to dental
erosion [72]. A high concentration of ascorbic acid (vitamin
C) was also found in Khat extract (25.72%). Every 1 g of Khat
contained 257.20 mg of vitamin C [52]. Another factor that
causes high water sorption is the greater erosive effect of acidic
media on the material surface. Material that is exposed to
acid provides less of a barrier for water molecules to enter the
polymer network, thereby increasing the water sorption [73].
Methodological limitations are inherent to all in vitro studies.
In the oral environment, however, saliva and other fluids may
dilute the stains. In addition to the presence of water, tem-
perature changes and pH levels in the oral cavity may affect
the properties of dental composite restorations. In this study,
flat specimen surfaces were used; clinically, composite resin
restorations have irregular geometric structures of convex and
concave surfaces. Furthermore, the colonization of bacteria
on polished or unpolished surfaces should be investigated
for possible differences in the kinetic cell growth and the
hardness of bacterial plaque. In addition, the immersion of
the specimens in different staining solutions and the absence
doi: 10.7243/2053-5775-7-1
of cleaning or brushing are significant factors affecting the
susceptibility of the materials to staining.
Conclusions
Within the limitations of this in vitro study, it can be concluded
that the composite resin type and staining solutions showed
high color change effects. Stain susceptibility changed not
only due to the material composition, but also by the staining
solutions. Therefore, practitioners should attempt to minimize
the discoloration of composite restorations by adopting suit-
able restoration types and educating patients on the staining
effects and erosive potential of soft drinks and other staining
solutions if they are heavily consumed.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
Authors’ contributions WAA AAM MAD AAA
Research concept and design ✓ ✓ -- --
Collection and/or assembly of data ✓ -- -- --
Data analysis and interpretation ✓ ✓ -- --
Writing the article ✓ ✓ ✓ ✓
Critical revision of the article ✓ ✓ -- --
Final approval of article ✓ ✓ -- --
Statistical analysis ✓ ✓ ✓ ✓
Acknowledgements and Funding
The authors would like to acknowledge the co-operation
received from the staff of Dental Polyclinics of the Dental
College, UST during data collection. This study was entirely
funded by University of Science and Technology, Sana’a, Yemen.
Publication history
Editor: Giuseppina Nocca, Catholic University of Sacred Heart, Italy.
Received: 07-Jun-2019 Revised: 14-Jul-2019
Accepted: 16-Jul-2019 Published: 26-Jul-2019
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